Aortopulmonary window associated with interrupted aortic arch: report of surgical repair of eight cases and review of literature. Thorac Cardiovasc Surg 2012 Apr;60(3):215-20
Date
01/19/2012Pubmed ID
22252330DOI
10.1055/s-0031-1298061Scopus ID
2-s2.0-84859630792 (requires institutional sign-in at Scopus site) 18 CitationsAbstract
BACKGROUND: Patients with combined aortopulmonary window (APW) and interrupted aortic arch (IAA) malformations are rarely seen. We reviewed cases with such association with emphasis on surgical management and long-term outcome.
METHODS: 109 patients with IAA and 25 patients with APW were operated upon between 1981 and 2011. The clinical records, operation and follow-up data were analyzed. Long-term outcome was completed with the help of either outpatient data or inquiring. Related literature was investigated.
RESULTS: Combined APW/IAA was found in 8 cases: 7.3% (8/109) of those with IAA diagnosis and 32% (8/25) with APW. All APWs were proximal. 7 patients had interruption type A. A ventricular septal defect (VSD) was associated in one case only. Median age at surgery was 10 days. The two first patients were operated upon without cardio-pulmonary bypass (CPB) and one died during operation. The other six underwent single stage approach under CPB with no death: overall early mortality of 12.5% (⅛). APW was closed with one or two patches; aortic arch was reconstructed either directly (extended end-to-side anastomosis) or by patch augmentation. There was no late death and no reoperation during mean follow-up of 118 months (range 1-360 months). Six patients were in functional NYHA class I, the remainder in class II. The cumulative APW/IAA incidence from literature varies between 4.9% (56/1105) and 22.2% (42/189). Early mortality reaches 15.1% (8/53) (95% CI: 6.8% - 27.6%).
CONCLUSION: Neonatal repair with thorough mobilization of the aortic arch and extended end-to-side anastomosis or use of patch augmentation carries potential for the best early and late outcome for combined APW/IAA malformation.
Author List
Murin P, Sinzobahamvya N, Blaschczok HCh, Photiadis J, Haun C, Asfour B, Hraska VAuthor
Viktor Hraska MD Professor in the Surgery department at Medical College of WisconsinMESH terms used to index this publication - Major topics in bold
Abnormalities, MultipleAorta, Thoracic
Aortopulmonary Septal Defect
Cardiac Surgical Procedures
Cardiopulmonary Bypass
Female
Germany
Heart Defects, Congenital
Hospital Mortality
Humans
Infant
Infant, Newborn
Male
Reoperation
Time Factors
Treatment Outcome
